P3470 - Impact of Low Fecal Elastase Level on Pancreatic Adenocarcinoma Outcomes: A Mayo Clinic Study

Chukwunonso Ezeani, MBBS¹, Oyedotun Babajide, MD², Chukwuemeka E. Ogbu, MD, MPH³, Tayyaba Bhatti, MD⁴, Michael Youssef, MD⁵, Lekhya Kollu, MD⁶, Deborah Adekunle, MD⁷, Philip Okafor, MD, MPH⁸, Osayande Osagiede, MBBS, MPH^8
1Baton Rouge General Medical Center, Baton Rouge, LA; ²New York Medical College Metropolitan Hospital, New York, NY; ³Cape Fear Valley Health, Fayetteville, NC; ⁴Western University, London, ON, Canada; ⁵University of Toronto, Ontario, ON, Canada; ⁶Lewis Katz School of Medicine at Temple University, Philadelphia, PA; ⁷Washington University School of Medicine in St. Louis / Barnes-Jewish Hospital, St. Louis, MO; ⁸Mayo Clinic, Jacksonville, FL

Introduction: Exocrine pancreatic dysfunction leading to diabetes mellitus (DM) frequently occurs prior to diagnosis with pancreatic adenocarcinoma (PDAC). However, due to population prevalence of DM, it is impractical to use changes in glycemic indices as biomarkers for PDAC. We hypothesize that exocrine dysfunction leading to a low fecal elastase impacts PDAC outcomes.

Methods: We performed a retrospective chart review of patients over 18 years diagnosed with PDAC with actual fecal elastase (FE) levels at all Mayo clinic sites. Patients with cystic fibrosis, celiac disease, Roux-en-Y bypass or pancreatic resection were excluded. Outcomes of patients with PDAC and FE-1 < 200 mcg/g were compared to those of patients with PDAC and FE-1 >200 mcg/g. Continuous variables were expressed as means and standard deviations and compared with the independent sample Students' T-test. Categorical variables were expressed as percentages and compared using Chi-squared testing. Two-tailed p-value of 0.05 was used to test for statistical significance. The primary outcome of overall survival and secondary outcomes of receipt of surgery, chemoradiation therapy and mortality were compared between groups using multivariable regression modeling.

Results: Among 66 PDAC patients, 49 (74.2%) had fecal elastase < 200 μg/g while 17 (25.8%) had levels >200 μg/g. Average age at diagnosis was 64.8 years. Fecal elastase (FE) indications included diarrhea (59.1%), weight loss (31.8%), abdominal pain (9.1%), and bloating (1.5%). The mean FE was 151.8 μg/g and 51.5% were female. On univariate analysis, no difference was seen in average survival among patients with FE < 200 vs those with FE >200 (3.2 years vs. 3.5 years, p=0.71). The same trend was seen in other secondary outcomes including receipt of surgery (44.9% vs. 47.1%, p=0.88), chemotherapy/radiation therapy (83.7% vs. 64.7%, p=0.16). Two-year survival and 5-year survival were comparable between both groups of patients p=0.52). On multivariable analysis, compared to those with FE< 200, patients with FE >200 had no increased odds of surgery (adjusted odds ratio [aOR]=1.49,p=0.774) , chemotherapy/radiation (aOR 2.07, 95% confidence interval 0.23-18.37, p=0.5) or death (AOR 0.69, 95% CI 0.13-3.68, P=0.66). Survival curve is attached in Figure 1.

Discussion: Patients with PDAC and FE-1 >200 mcg/g may have longer survival compared with those with FE-1 < 200 mcg/g but this did not meet statistical significance. More research is needed to assess the impact of low FE-1 on PDAC outcomes.



Disclosures:


Chukwunonso Ezeani, MBBS¹, Oyedotun Babajide, MD², Chukwuemeka E. Ogbu, MD, MPH³, Tayyaba Bhatti, MD⁴, Michael Youssef, MD⁵, Lekhya Kollu, MD⁶, Deborah Adekunle, MD⁷, Philip Okafor, MD, MPH⁸, Osayande Osagiede, MBBS, MPH⁸. P3470 - Impact of Low Fecal Elastase Level on Pancreatic Adenocarcinoma Outcomes: A Mayo Clinic Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.